DBH: Timesheets and Canceled Visits on Children’s Therapy Bills

Developmental Behavioral Health, Inc. and its Colorado Springs doctor agreed to pay $86,675 to settle allegations of TRICARE therapy billing fraud. The DBH fraud case concerned administrative work, canceled appointments, supplies, and food. The government alleged that hundreds of claims reached a military health insurance program meant to pay for children’s therapy. For someone inside a therapy practice, the distinction is familiar: the time recorded on a timesheet, the visit on a calendar, and the treatment a child actually receives can tell different stories.

The U.S. Attorney’s Office for the District of Colorado announced the settlement on September 22, 2014. The allegations covered claims from 2008 through 2013. The doctor provided therapy to children with developmental disabilities, and the government alleged that he and DBH also charged TRICARE for administrative services.

Timesheets, Canceled Appointments, Supplies, and Food

The DBH TRICARE billing allegations reached ordinary tasks and expenses inside the practice. The government specifically identified time spent filling out timesheets, time assigned to canceled appointments where no therapy occurred, and time or money spent on supplies or food.

The timesheet allegation is particularly telling. The government’s allegation concerned charging the health insurance program for the time spent completing that paperwork. We see the absurdity in asking a program that pays for a child’s therapy to pay for filling out the staff timesheet as well.

Canceled appointments expose a different gap. In the claims the government described, no therapy was provided during the canceled visit. The government alleged that the practice collected payment for that time. A space on the calendar, billed as care.

Supplies and food add another distinction: money spent by a practice versus a service furnished to a child. The government alleged improper charges for both the time and the money spent on those items. Someone who handled purchasing or administrative work could recognize that difference without having delivered the therapy.

What TRICARE Was Paying For

TRICARE paid for therapy services to children with developmental disabilities who were children of military members. In its account of the DBH case, the U.S. Attorney’s Office stated that the program covered that therapy but did not pay for administrative services.

In behavioral health care, payment can be tied to minutes of treatment, a group session, or a broader treatment program. Staff time does not automatically become a separate billable service. The DBH allegations put that distinction into everyday terms: time spent completing a timesheet was being charged to a program paying for the child’s therapy.

We look at who decided that an activity belonged on a therapy bill. An employee who knows how the practice assigned administrative work can explain a charge that a billing total alone cannot.

Administrative Work Charged Against a Child’s Therapy

Early Autism Project provides a close comparison. In its August 2018 settlement announcement, the U.S. Attorney’s Office for the District of South Carolina alleged that the company required therapists to reserve billable hours for Regional Leads and Regional Coordinators. Those employees allegedly performed administrative and management functions without actively working with the child whose hours were used.

That administrative-work allegation concerned South Carolina Medicaid’s PDD Waiver. The government separately alleged that Early Autism Project allowed therapists to pad therapy hours billed to both TRICARE and South Carolina Medicaid. The company paid $8,833,615 to resolve the False Claims Act investigation, which arose from a former employee’s whistleblower lawsuit.

At Early Autism Project, the government alleged a system for assigning company administration to children’s therapy hours. At DBH, it identified timesheets, canceled visits, supplies, and food. Both accounts put the same business decision in view: which activities the provider charged to a program paying for a child’s treatment.

For an employee familiar with staffing assignments, that can be a much more recognizable issue than a broad accusation of healthcare fraud. The work may have happened exactly as assigned. What matters is how the company represented that work when it asked the government to pay.

Other TRICARE Cases Show Why the Claim Details Matter

TRICARE therapy claims can misrepresent the service even when a child attends. In the Autism Concepts settlement announced in October 2019, the government alleged that the company and its director claimed individual applied behavior analysis services while providing services to groups of children simultaneously. The company and director agreed to pay $300,000. That allegation concerned how the session was described, while DBH’s canceled-appointment allegation concerned therapy that did not occur.

The hours and the worker named on the claim also matter. In a settlement with the former owner of The Shape of Behavior, the government alleged that company locations submitted claims that misrepresented the actual rendering providers, lacked support in medical records, or billed excessive hours for individual providers on particular dates. Humana Military Program Integrity uncovered the alleged improper claims, prompting the investigation.

The Settlement and the Separate Consent Judgment

The DBH settlement paired the payment agreement with a much larger consent judgment, a court order the doctor and company agreed to. The doctor had to pay $1,400 per month toward the settlement. Against that payment arrangement stood a $1,283,027 judgment entered by the U.S. District Court for the District of Colorado.

The government could enforce the full judgment if the doctor failed to make the settlement payments. We see a striking contrast: hundreds of allegedly improper claims, followed by monthly installments, with the larger judgment held in reserve.

The Defense Criminal Investigative Service investigated the matter, with significant assistance from the Defense Health Agency’s Office of Program Integrity. The U.S. Attorney’s Office for the District of Colorado handled it.

Who Sees TRICARE Therapy Billing Fraud From Inside?

A therapy worker may know what happened during the time billed. An administrator may know which appointments were canceled or what time went into paperwork. A billing employee may know how those activities became claims. For the conduct alleged in the DBH case, each perspective helps connect the practice’s daily work to the money it sought from TRICARE.

We shape what you know into a whistleblower case and stay with you through it. The important conversation begins with the discrepancy you saw: an appointment that never happened, administrative time assigned to therapy, or expenses appearing where treatment should be. You bring the knowledge of the practice. We bring the experience of developing a whistleblower case.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

Talk to Us About the Therapy Bills

If you saw timesheets, cancellations, or operating expenses charged as children’s therapy, speak to one of our whistleblower experts about the therapy bills you saw. We build your case with you and bring in behavioral health fraud whistleblower lawyers who understand TRICARE billing. We stay beside you through the process, working toward your strongest TRICARE whistleblower case.